It is a scenario familiar to many in the medical profession: A patient comes in complaining of an upper respiratory infection — a cough or cold. He wants the doctor to prescribe an antibiotic. The doctor knows the infection is almost certainly viral, and will resolve itself on its own. But even after the doctor explains that, the patient wants the antibiotic “just in case.” Rather than arguing, because she is facing the pressures of time, the doctor gives in to the request.

Such unnecessary use of antibiotics adds to antimicrobial resistance and could lead us to an “apocalypse” where penicillin and other bacteria-fighting drugs no longer work. That, at least, was the gist of a report published earlier this month by the United Kingdom’s chief medical officer, Dame Sally Davies, a medical doctor.

The common practice of using antibiotics to promote growth in farm animals must be banned immediately as part of a campaign to combat drug-resistant infections in humans, one of the country’s largest doctor groups urges in a new report.

The problem of bacteria impervious to antibiotics has moved beyond the oft-reported super bugs like MRSA (methicillin-resistantStaphylococcus aureus) and C. difficile, and affects a “multitude” of common infections from strep throat to salmonella, the Ontario Medical Association (OMA) warns.

People are already suffering more serious illness and spending longer in hospital because of the resistance, something that will become routine without prompt action, it adds.

“The impact on patients has reached a dangerous level,” says the report.

“Antimicrobial resistance is a ticking time-bomb not only for the U.K. but also for the world,” Dame Davies said. “We need to work with everyone to ensure the apocalyptic scenario of widespread antimicrobial resistance does not become a reality. This threat is arguably as important as climate change.”

What’s she talking about? Many of us have heard of such bacterial infections as E. coli and C. difficile and Staphylococcus aureus. But few of us are aware of their constantly-evolving nature. Kill one with one kind of antibiotic, like penicillin, and it’s possible for the bacteria to evolve a new kind though genetic mutations, which is then resistant to the antibiotic.

“Today we are seeing rates of resistance that would have been unthinkable even 10 years ago,” says Dr. Lynora Saxinger, chair of a Canada-wide committee that advocates for responsible use of antibiotics, in a press release.

The problem arises because the development of new drugs has slowed in the last three decades. Meanwhile, antibiotic-laced agricultural feeds may be promoting the proliferation of drug-resistant bacteria. Continuing this trend leads us to a future where few of our antibiotics work.

Hospital-acquired infections result in 8,000 to 12,000 deaths a year — and those stats could worsen as antibiotic resistance increases

As it is, approximately 5% to 10% of hospitalized patients contract an infection during their stay. Canadian data from 2005 posits that 220,000 to 250,000 annual hospital-acquired infections result in 8,000 to 12,000 deaths a year — and those stats could worsen as antibiotic resistance increases. Patients also underestimate the potential for side effects. Recently, for example, the popularly prescribed antibiotic azithromycin was linked to heart side effects.

So what to do? Well, one thing Davies suggests is to use antibiotics a lot more sparingly. Back when I was in training, I can remember a doctor counselling the other residents and I. Don’t overprescribe, she said, but if you need to get a patient out of your office, the fastest way is to just write a prescription. This was in the early 1990s, so it’s no wonder that we’re now seeing increasing reports of Methicillin-resistant staph aureus (MRSA) and Vancomycin-resistant Enterococcus (VRE) outbreaks in Canada.

Attitudes have changed a lot since the early 1990s. Antibiotic prescription is trending slightly downward. But people keep asking for their meds — and arguing with you if you don’t supply them. At the clinic where I’m medical director, we track the performance of our doctors with client satisfaction scores, among other measures. One of our doctors commented recently that his client ratings would go up a lot if he prescribed all the antibiotics that people requested.

That’s not strictly true, however. In fact, studies show that prescribing antibiotics has not been shown to be a determinant of patient satisfaction. Rather, researchers have linked patient satisfaction to physicians who take the time to explain the rationale for avoiding prescribing.

Studies have shown antibiotic prescriptions decrease if doctors educate patients about antibiotics and the potential for danger if they’re overused. Heading off an antibiotic apocalypse will require physicians to follow antibiotic stewardship by essentially becoming a lot more stingy with how often they prescribe them. We should prescribe less than we do, and we should prescribe shorter courses of medication (five to seven days), to reduce the likelihood people will have leftover stores of drugs that they’ll use to self-medicate — which in turn can lead to more antibiotic resistance.

So here’s a request: Don’t get mad at your doctor when he or she doesn’t write you a prescription. They are probably doing you a favour. Antibiotic prescription is one of those cases where the old adage applies: Less is more.